At least 1 year(s)
Clinical Quality RNs conduct clinical quality audits and peer reviews, compile and maintain report data in a standard format to support accreditation and regulatory requirements. They are responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement. They assist in the application and interpretation of data to drive quality improvement efforts. Responsibilities: Completes standard quality reviews and audits, reports and analysis within agreed upon deadlines
Routinely analyzes results of quality reviews to identify and report error trends
Monitors clinical indicators and performance measures, conducts gap analyses and collaborates with others in the development and implementation of improvement efforts.
Conducts Early and Periodic Screening, Diagnostic and Treatment outreach, education and tracking of children, teenagers and young adults under age 21 enrolled in the health plan
Reviews issues/trends, develops interventions when needed, and reports relevant issues/trends to the site Quality Management (QM) Committee
Provides internal and external training for organizations, providers, and other identified groups to improve understanding of quality and EPSDT programs
Manages assigned special projects to completion within target date
Utilizes quality system tools/databases to capture relevant data
Develops creative solutions to address identified quality problems
Demonstrates leadership in continuous quality improvement
Utilizes change management to drive results
Develops recommendations for quality remediation plans
Shares best practices and supports team goals and objectives
Drives consistency and efficient processes on the team
Actively participates in quality improvement initiatives/meetings
Responsible for maintaining and increasing self-proficiency in the use of quality tools and methods and the application of quality science
UnitedHealthcare Community & State is part of the family of companies that make **MEMBERS ONLY**SIGN UP NOW***. one of the leaders across most major segments of the US health care system.If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Hawaii RN License
Undergraduate degree in nursing (ADN or BSN) or equivalent experience required.
1 year experience working with the Pediatrics' population
3 years of clinical experience in a health care setting required; quality audit review and analysis experience in a health care setting or managed care organization is preferred.
Knowledge of health care products, delivery systems, claims processing and supporting systems.
Knowledge of quality improvement methods and tools (eg. TQM, Six Sigma) preferred.
Knowledge of sampling methods and measurement techniques preferred.
Practical knowledge of Microsoft Word, Excel and PowerPoint applications
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V**MEMBERS ONLY**SIGN UP NOW***. is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.